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PHRM 865 > Exam 5: CNS Infections > Flashcards

Exam 5: CNS Infections Flashcards

1
Q

Types of CNS infections

A

meningitis, encephalitis, brain abscess, ventriculitis, subdural empyema, CSF shunt infections

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2
Q

Function of skull, vertbrae

A

act as a shock absorber for brain and spinal cord

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3
Q

what produces CSF

A

choroid plexus

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4
Q

Normal CSF composition

A
  1. clear
  2. protein concentration <50
  3. Glucose concentration 50-66%
  4. pH of 7.4
  5. Wbc <5
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5
Q

what are the meninges

A

protective covering of the brain and spinal cord

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6
Q

3 layers of meninges

A

dura matter
arachnoid
pia mater

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7
Q

what is meningitis

A

infection of the subarachnoid space (b/w pia and arachnoid

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8
Q

BBB composition

A

tightly join capillary endothelial cells that produce tight junctions similar to a lipid bilayer

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9
Q

BBB function

A

separate blood from brain tissue

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10
Q

BBB and drugs relationship

A

drugs enter brain tissue by direct passage through capillary endothelial cells

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11
Q

BCSFB composition

A

consists of tightly fused ependymal cells, which line the ventricular side of the choroid plexus

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12
Q

BCSFB function

A

separated blood from CSF

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13
Q

ependymal cell function

A

restrict diffusion of drugs and chemicals into CSF to serve as a barrier to antimicrobial penetration into the CSF

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14
Q

Lipid Solubility and CSF penetration

A

lipid soluble drugs penetrate brain tissue more readily than hydrophilic drugs

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15
Q

Ionization and CSF penetration

A

only unionized drugs can diffuse

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16
Q

protein binding and CSF penetration

A

only free drug can penetrate

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17
Q

molecular weight and CSF penetration

A

agents with low molecular weight penetrate barrier

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18
Q

degree of meningeal inflammation and CSF penetration

A

penetration of some drugs into CSF is enhances with inflammation; decreased penetration as healing progresses

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19
Q

Therapeutic CSF concentrations with or without meningeal inflammation (8)

A
  1. acyclovir
  2. chloramphenicol
  3. fluconazole
  4. ganciclovir
  5. linezolid
  6. metronidazole
  7. rifampin
  8. ? FQ
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20
Q

Therapeutic CSF concentrations WITH meningeal inflammation (6)

A
  1. penicillins
  2. 3rd and 4th gen cephs
  3. aztreonam
  4. meropenem
  5. colistin
  6. vanc
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21
Q

Therapeutic CSF concentrations NOT achieved with or without meningeal inflammation

A
  1. AG
  2. Amp B
  3. Beta lactamase inhibitors
  4. 1st and 2nd gen ceph
  5. Clindamycin
  6. Tetracycline
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22
Q

Pathogenesis of meningitis

A

Bacteria gain access into CSF through contiguous spread from a parameningeal focus so pathogens penetrate CSF while draining via CNS veins or eroding through bony structures

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23
Q

bacterial meningitis likely causative pathogen: neonates <1 month

A

group b strep
e. coli
listeria

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24
Q

bacterial meningitis likely causative pathogen: children 1 mo-4yr

A

h. flu
s. pneumo
n. meningitidis

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25
Q

bacterial meningitis likely causative pathogen: children, adults >4-29 yrs

A

n. meningitidis

s. pneumoniae

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26
Q

bacterial meningitis likely causative pathogen: adults 30-50 years

A

s pneumoniae

n. meningitidis

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27
Q

bacterial meningitis likely causative pathogen: older adult >50 yrs

A

s pneumo
n mening
gnr
listeria

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28
Q

bacterial meningitis likely causative pathogen: post neurosurgery

A

s. aureus
gnr
s. epidermidis

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29
Q

bacterial meningitis likely causative pathogen: head trauma

A

s. aureus

GNR

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30
Q

bacterial meningitis likely causative pathogen: immunocompromised

A

s pnuemo
n mening
listeria
GNR

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31
Q

what bacteria account for >80% of cases

A

h. influenzae
n. meningitidis
s. pnuemonae

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32
Q

Bacterial menigitidis clinical signs and symptoms: adult

A

fever
headache
stiff neck
photophobia

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33
Q

Bacterial menigitidis clinical signs and symptoms: young infants

A

fever

SZ

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34
Q

Bacterial menigitidis clinical signs and symptoms: elderly

A

low grade fever

stiff neck

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35
Q

Bacterial menigitidis clinical signs and symptoms: older children

A

changes in activity level
lethargy
confusion

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36
Q

common clinical presentation of meningococcemia

A

rash

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37
Q

chemistry of CSF examination in meningitis

A

< 50% serum

High protein 100-500

38
Q

hematology of CSF examination in meningitis

A

WBC >400-5000

Differential >80% neutrophils

39
Q

When to begin empiric therapy for bacterial meningitis

A

immediately after LP is performed

40
Q

Basis of empiric therapy for bacterial meningitis

A
  1. . most probable organism
  2. antibiotic characteristics
  3. patient characteristics
41
Q

antibiotic characteristics needed for bacterial meningitis

A
  1. high dose
  2. penetration into csf
  3. bactericidal activity
42
Q

goal of treating bacterial meningitis

A

rapid sterilization of CSF, resolution of signs and symptoms, decrease mortality, and prevention of neurologic sequelae

43
Q

bacterial meningitis recommended therapy: neonates

A

ampicillin + cefotaxime

44
Q

bacterial meningitis recommended therapy: infants, children

A

3rd gen ceph + vanc

45
Q

bacterial meningitis recommended therapy: children, adults

A

3rd gen ceph + vanc

46
Q

bacterial meningitis recommended therapy: adults

A

3rd gen ceph + vanc

47
Q

bacterial meningitis recommended therapy: older adults, immunocompromised

A

amp + 3rd gen ceph (4th gen if immuno/elderly) + vanc

48
Q

bacterial meningitis recommended therapy: post neurosurgery

A

vanc + 3rd or 4th gen ceph

49
Q

bacterial meningitis recommended therapy: head trauma

A

vanc + 3rd or 4th gen ceph

50
Q

bacterial meningitis directed therapy and duration: PSSP

A

gen G or ampicillin for 10-14 days

51
Q

bacterial meningitis recommended therapy: PRSP

A

van + ceftriaxone for 14-21 dqays

52
Q

bacterial meningitis recommended therapy: group B strep

A

ampicillin +/- gentamicin for 14 to 21 days

53
Q

bacterial meningitis recommended therapy: MSSA

A

naficillin for 14 to 21 days

54
Q

bacterial meningitis recommended therapy: MRSA

A

14 to 21 days

55
Q

bacterial meningitis recommended therapy: l. monocytogenes

A

ampicillin +/- gentamicin for 21 days

56
Q

bacterial meningitis recommended therapy: n. meningitidis

A

penicillin or ceftriaxone for 7-10 days

57
Q

bacterial meningitis recommended therapy: h. influenzae

A

BL- ampicillin, BL + ceftriaxone for 7 to 10 days

58
Q

bacterial meningitis recommended therapy: gram negative

A

ceftriaxone or cefepime for 21 days

59
Q

role of steroids in bacterial meningitis for children

A

adjunctive therapy in h. influenzae in pediatrics b/c it decreases the incidence of neurologic sequelae and hearing impairment

60
Q

role of steroids in bacterial meningitis for adults

A

useful in adults with pneumococcal meningitis b/c decrease in mortality and unfavorable outcomes

61
Q

when to administer steroids in bacterial meningitis

A

before or with 1st dose of the antibiotic

62
Q

prophylaxis of bacterial meningitis

A

prophylaxis should be administered to close contacts of index case to eliminate nasopharyngeal colonization, decrease transmission of the organism, and prevent the development of meningitis

63
Q

what is considered a close contact for bacterial meningitis

A

household member, someone sharing sleeping quarters, daycare attendee, NH resident, anyone in crowded confined area with index case

64
Q

Prophylaxis regimens adults: neisseria meningitidis

A

rifampin 600mg q12h x4 doses

65
Q

Prophylaxis regimens adults: h. influenzae

A

600mg qd x4 days

66
Q

Prophylaxis regimens children: neisseria meningitidis

A

rifampin 5-10 mg/kg PO Q12H x4 doses

67
Q

Prophylaxis regimens adults: h. influenzae

A

rifampin 10-20 mg/kg PO QD x4 days

68
Q

most common cause of fungal meningitis

A

cryptococcus neoformans

69
Q

Cryptococcal meningitis treatment: non-HIV

A

AmB 0.7-1 mg/kg/day or Lip AmB 3-4 mg/kg/day or Abelcet 5mg/kg/day
+ flucytosine 25mg/kg PO QID x14

followed by fluconazole 400mg PO or IV QD x10-12 weeks

70
Q

Cryptococcal meningitis treatment: HIV

A

Lip AmB 3-4mg/kg IV
+ flucytosine mg/kg PO QID x2 weeks

then fluconazole 400mg PO or IV qd for 8-10 weeks

then fluconazole maintenance therapy for at least one year

71
Q

what is encephalitis

A

inflammatory process of the brain parenchyma in association with clinical and lab evidence of neurologic dysfunction

72
Q

CSF analysis in encephalitis

A

mildly decreased glucose
elevated protein
high WBC

73
Q

treatment of herpes simplex of varicella zoster encephalitis

A

acyclovir 10mg/kg IV q8h x 2-3 weeks

74
Q

treatment of CMV encephalitis

A

ganciclovir + foscarnet IV for 2 to 3 weeks (HIV infected patients)

75
Q

ways bacteria can gain access into and invade tissue

A
  1. contiguous spread
  2. hematogenous spread
  3. direct inoculation
76
Q

bacterial etiology of brain abscess: otitis media or mastoiditis

A

streptococci
bacteroides
prevotella
GNR

77
Q

treatment of brain abscess: otitis media or mastoiditis

A

3rd gen ceph + metronidazole

78
Q

bacterial etiology of brain abscess: sinusitis

A 
streptococci
bacteroides
GNR
s. aureus
h. influenzae
79
Q

treatment of brain abscess: sinusitis

A

3rd gen ceph + metronidazole

80
Q

bacterial etiology of brain abscess: dental sepsis

A

fusobacterium
bacteroides
prevotella
viridans streptococci

81
Q

treatment of brain abscess: dental sepsis

A

penicillin + metronidazole

82
Q

bacterial etiology of brain abscess: post neurosurgery, penetrating head trauma

A

s. aureus
streptococci
GNR
clostridium

83
Q

treatment of brain abscess: post neurosurgery, penetrating head trauma

A

vanc + 3rd of 4th gen ceph

84
Q

bacterial etiology of brain abscess: bacterial endocarditis

A

s. aureus

viridans streptcocci

85
Q

treatment of brain abscess: bacterial endocarditis

A

vanc + gentamicin

86
Q

bacterial etiology of brain abscess: lung abscess, empyema

A 
fusobacterium
actinomyces
bacteroides
prevotella
viridans streptococci
87
Q

treatment of brain abscess: lung abscess, empyema

A

penicillin + metronidazole (+ sulfonamide for nocardia)

88
Q

bacterial etiology of brain abscess: HIV infected

A

toxoplasma
nocardia
cryptococcus

89
Q

third gen cephs to use for brain abscess

A

ceftriaxone or cefotaxime

90
Q

what four gen ceph to use if pseudomonas suspected

A

cefepime

91
Q

adjunct therapy for brain abscess

A

corticosteroids for patients with surrounding edema

PHRM 865 (59 decks)

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